Workers’ compensation claims are denied for reasons ranging from insufficient documentation to questions about the validity of the claim. A Chicago workers’ comp attorney can help prepare and pursue an appeal of the denial.
Common Reasons that Claims are Denied
- Injury is not reported on time (In Illinois it must be reported within 45 days of the injury)
- Claim is not filed within the statute of limitations
- Injury is not considered work-related
- No medical treatment was administered
- Employer disputes the claim
In each of these cases, workers have the right to appeal and show evidence countering the reasons for the denial. This evidence and reasoning must be thorough in order for an appeal to be successful. This may require doctor’s visits, explanation of documentation, or actions that specifically address the reasons the claim was denied.
The Appeal Process
A Chicago workers’ comp attorney can help prepare an appeal for a denied workers’ compensation claim. This must be filed within three years following the injury, or within two years of the last compensation payment received by the injured party.
Following a denial, individuals must file an application for adjustment of claim. This must be filed with proof that the employer has been served a copy of the application. Once this is done, it is necessary to request a hearing with an arbitrator working with the Illinois Workers’ Compensation Commission. The hearing does not change the denial. It is an opportunity to provide evidence that shows the denial was in error.
If there is sufficient evidence, the next step is to request a trial. This typically happens within 30 days. The arbitrator will seek to resolve the dispute during the trial and will issue their decision within 60 days of its conclusion, based on the evidence and information that is presented.
If the arbitrator’s decision is not satisfactory, there is one more step that can be taken. It is possible to appeal the arbitrator’s decision via a Petition for Review with the Workers’ Compensation Commission. This must be done within 30 days. Once received, a panel of three commissioners will review the petition and issue a decision within 60 days of hearing the case.
Should the WCC deny the claim, it is possible for any individual not employed by the state to appeal via the Circuit Court, Appellate Court, or even the Illinois Supreme Court.